Exam: 1, Spiff : 0. The exam was extremely difficult. I didn't study all of the microbial toxins in detail, and, guess what was tested? Toxins. The next segment of micro will be viruses and parasites, while genetics will instruct me regarding cancer, lysosomal storage diseases ( Tay Sachs, Reffsums, Zellwegers, Gaucher's, etc). Genetics is shaping up to be much easier than my college genetics class. Before medical school, I thought that all of the classes would be much more difficult than in undergrad. The material itself is about at the 300-400 level, maybe a intro level grad course. In other words, it's not too complex. What makes it more challenging is the pace, which, while exhilirating, leaves no margin for error or illness. I would liken a medical school course to taking a 300 level course at 3x speed. We literally spent 1 week on information that it took me 4 weeks to cover in undergrad.
I recently read " Another day in the frontal lobe", by Dr. Katrina Firlink, a neurosurgeon. On the whole, the book is a little disorganized and the subtle traces of a hypercompetitive emotionally isolated author bleed through. Physicians (and nurses too) negotiate critical nexuses in the lives of their patients, which can make for poignant anecdotes. The author of "Another Day in the Fronal Lobe", however, relates these stories in a way that feels contrived, as though she is telling them to be seen as the tortured neurosurgeon, when she is in reality more callous or withdrawn. An amateur gestalt analysis of the author reveals her to be competitive, slightly coarse, and subtly overcompensating for some ancient flaw. Perhaps I judge her too harshly, though, as the practice of clinical medicine is still several years away for me, and I don't know how I will react to the daily grind of illness and pain.
I was particularly astonished at the contrast in my perception of futility versus that of the cowboy neurosurgeon. Why wheel an obtunded, terminal patient into the OR simply to prolong a ''life" by 2 weeks (note, this surgery was not about pain relief)? Especially if this was against the patients explicitly stated wishes? What are we treating here? the patient? or the doctor's own unwillingness to let go?
We have been discussing medical futility in my ethics course recently, and it seems remarkable that the class, as a whole, seems to be in general agreement on what constitutes a 'futile' intervention. Equally incredible is that most people seem to agree that maintaining someone in a PVS (persistent vegetative state: where the patient has no higher brain functions, but can breath and maintian heartbeat. The patient will have normal sleep/wake cycles, but is completely unresponsive to stimuli) indefinitely is ethically wrong. Perhaps it is our callous youth that enables us to judge the family members who choose this course as being wrong. Personally, I do think that such behavior is wasteful and unneccessary, though if it were my child on the bed, I would undoubtedly have a different, or at least more well informed, opinion. With such ticklish issues to discuss, what surprises me is the near unanimity of opinion regarding theses topics. The "right to die" discussion (FYI, there is no legally defined "right" to die. it doesn't exist in US law. ) was slightly more animated, but I think most of the people in my class, if practicing in Oregon, would never intentionally prescribe a lethal dose of medication. I'm not sure where I'm going with all this, but I hope to adress these topics again when I have more experience on the wards.
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